Health Care Reform begins with the Individual

It’s great to hear a voice of reason amidst all this mudslinging, particularly in the USA where the possibility of any major reform is dimming by the day. And it comes in the form of an MD who reminds us that ultimately it is individuals that are responsible for their care and that much illness is preventable by better behaviour.

While we focus on the cost of drugs, procedures and insurance, it is easy to forget that we are treating people that are sick for a reason. In Australia, as in much of the USA, our current system is basically like going shopping with someone else’s credit card — no limit, no penalty, no shame. People have very little to discourage them from getting overweight, for example.

Now before you suspect me of promoting draconian fat-taxes and like measures – hear me out. The best guarantee of health in any society are norms and customs that strongly encourage healthy living. These take time, however, to develop, and can easily be lost. Then there will always be those that ignore them anyway. As it stands we have a long way to go before people are fully empowered to aim for better health.

For this reason there is increasing focus on health education. But more can be done. One great suggestion is the idea of an ‘individual health road map‘. This is a plan given to you by your health care provider that outlines all the critical steps required for an individual to maintain, insofar is is humanly possible, their health. For example, a diabetic could be given the standard of care plan for diabetics, and if he/she actually showed up, without fail, to the doctor, the podiatrist, the nutritionist and followed their subsequent recommendations, he would be less likely to require hospitalisation and expensive treatment and society would not shoulder his cost. If he misses these critical steps in his care, he pays, not us.

Obviously, any similar system must be implemented with great concern for people’s well-being – and no-one should ever be refused health care. But as it stands, we have low expectations of individuals and place very little pressure on people to truly live healthy lifestyles. Such a form of insurance may be the best reform yet.

I’m also encouraged to read that another web-based patient support tool is being developed. It’s part electronic medical record, part drug encyclopedia, and part patient chart known as the Pediatric Knowledgebase (PKB).

The PKB integrates the hospital’s medical records with drug-specific decision support generated by clinical pharmacology experts and clinical caregivers and predictive models generated by a hospital’s pharmacometric and informatics team. Forecasting tools evaluate dosing scenarios to be explored via a user friendly interface that front-ends a pediatric population-based PK/PD model. The result is therapeutic drug monitoring for children that uses patient data to help predict outcomes and inform clinical decisions in individual patients.

Australian eHealth Update

A recent presentation (Jul ’09) from the NEHTA CEO Peter Flemming courtesy of ACHSE.

Distinction between EHR and EMR

I didn’t know there was one, but according to the Health Information and Management Systems Society, there is! Read about that difference here.

Mobile Phones the next Health Platform

Mobile phones could be the next major platform for personal health monitoring tools, experts say.

In the future, people could use mobile phones to share, store and add information to their personal medical records. In addition, people with chronic conditions could use special add-on devices to monitor diabetes, blood pressure or oxygen levels in their blood.

In an iHealthBeat Special Report by David Gorn, experts discussed the potential applications of mobile health monitoring technology.
http://www.ihealthbeat.org/special-reports/2009/mobile-phones-could-store-electronic-health-records-boost-personal-health-monitoring.aspx

EHR Plays Key Role in Personalized Medicine Study

From http://health-care-it.advanceweb.com

Through the study of genetic links between patients and chronic diseases, researchers at Geisinger Health System in Danville, Pa., are hoping to gain a better understanding of how to prevent, diagnose and treat these diseases.

A new program at Geisinger called MyCode is capitalizing on the health system’s unique ability to utilize its integrated infrastructure to link genomic information with an advanced electronic health record (EHR) system and fast-growing biobank. The result is a tool that is the bridge to Geisinger’s personalized medicine program — an initiative that promises to ultimately re-engineer the paradigm of health care from reactive to predictive and, with the help of researchers and physicians, engage patients in their personal health and wellness.

Geisinger patients learn about MyCode at Geisinger Medical Group sites, and about 90 percent choose to participate. With written consent, participants agree to provide a deoxyribonucleic acid (DNA) sample — chemical material that is inherited and extracted from a blood sample — at their next scheduled blood draw. From there, the sample is linked with EHR information and routed to the system’s biobank for quick researcher access.

Since launching the MyCode pilot program two years ago, researchers have collected 20,000 DNA samples. Samples generally fall into two groups: those from patients seeking general health and wellness care from their family physicians and those from patients seeking specialty medical care, such as bariatric surgery.

These samples are helping Geisinger researchers gain critical insight into patients’ risk of chronic health conditions, such as abdominal aortic aneurysms, severe asthma, depression, obesity, familial ureterocoele, digoxin/phenytoin toxicity, overactive bladder syndrome and various pain conditions.

“This information will ultimately improve health by motivating people to make positive lifestyle changes, such as exercising, eating healthy, quitting smoking as well as decisions to seek further medical evaluation and preventive strategies,” said Geisinger Center for Health Research Director Walter “Buzz” Stewart, PhD, MPH.

A number of safeguards protect the privacy of participants’ genetic and EHR information. Confidentiality and subject anonymity are strictly maintained by de-identifying the samples. Samples are assigned specific identification numbers, encoded, encrypted and entered into a secure database. A governance board — with Geisinger and non-Geisinger representation — meets several times a year to audit the process.

“The goal of MyCode is to translate genetic data into specific knowledge about a disease that is clinically relevant and will enhance patient care,” said Glenn Gerhard, MD, staff scientist and director of Geisinger’s Genomics Core.

“MyCode aims to discover genes that increase a person’s risk of chronic disease and help us understand why people respond differently to treatments,” explained Weis Center for Research Director David Carey, PhD. “The more we know about the causes of disease, the greater our ability to provide more effective treatment and, ultimately, prevent disease from occurring.”

According to Dr. Carey, by matching genes with a comprehensive profile of a specific chronic condition, researchers are able to study groups of patients with similar signs and symptoms, and begin to predict and understand how they will respond to a specific treatment or medication.

“This project provides the opportunity to move genetics from the laboratory directly to patient care,” explained Dr. Stewart. “MyCode is driving research that promises to improve the health and health care of patients nationwide.”

Patients may want Smartcards, but are they a Smart Idea?

This recent study is meant to be further impetus for those interested in the concept of smartcards. The lead author suggests that the major benefit of the smartcards will be to save time. He says “it’s quicker for a doctor to push a card into a machine a press a few buttons than it is to request a medical chart to come from medical records”. Agreed. But is it the best way?

The concept of using a card for anything is already decidedly 20th century (we are in the 21st remember). Mobile phones and other handheld devices are moving towards incorporating RFID and other wireless technology that will render bank and other cards inefficient.

Furthermore, the concept of keeping data on a card as opposed to in cyberspace is also old hat!